March 3, 2017

Patient Surveys Change Doctors' Bedside Manners

Doctors took note when patients gave them mediocre ratings, taking steps to improve communication. Things got better.

Communication is more an art than a science. That's one reason there's been little effort made to teach doctors how to communicate better with their patients. Luckily, better communication is neither hard to do nor expensive, as a study in a Utah hospital shows.

The study focused on doctors, known as hospitalists, who worked exclusively in the hospital and a survey, HCAHPS, that patients fill out after they are released from the hospital. Answers on HCAHPS can affect a hospital's federal funding, with dissatisfied patients leading to lower funding.

Luckily, better communication is neither hard to do nor expensive, as a study in a Utah hospital shows.

The survey results had been getting worse for this group of doctors, so it was decided to try to do something to help improve patient satisfaction.

Everybody has their own communication style but, given the dismal results, it was decided that some standardization in how the doctors interacted with the patients was needed. This was broken down into four major areas:

1) Doctors need to pay attention to non-verbal communication and basic courtesies, such as knocking prior to entering examination rooms, closing doors or curtains to ensure privacy and sitting at eye level with patients when talking to them.

2) Bedside discussions should include asking patients about how they are feeling and their pain level, informing them of any important results from exams or tests and letting a patient know what the doctor sees as their major health problems and status — stable, improving or worsening.

3) Doctors should summarize findings and treatment plans in plain English, covering the reason the patient has been admitted to the hospital, the plan for the day and when the doctor would be coming back.

4) Before leaving, doctors should make sure that patients don't have any further questions or concerns, by asking them; perhaps saying, “Did I explain everything in a way that makes sense?”

These suggestions can be thought of as a checklist, and its basics were included on a laminated card given to all hospitalists. When the hospitalists met at the beginning of the week, the cards were reviewed to reinforce the concepts. And the latest survey ratings were reviewed at least monthly, to see if the changes were having any effect and forcing the doctors to keep them in mind.

The program did indeed make a difference. The downward trend in patient satisfaction was reversed for patients of the hospitalists. This is best shown by the changes in how many patients answered “always” to three key survey questions:

  • How often did doctors explain things in a way you could understand? — Those answering “always” rose from 64% to 72 percent.
  • How often did doctors listen carefully to you? — Those answering “always” rose from 69 to 74 percent.
  • How often did doctors treat you with courtesy and respect? — Those answering “always” rose from 81 to 84 percent.
  • The number of patients who answered “always” to all three questions was taken as a general measure of how well doctors were communicating with them. This rose from 56 to 63 percent. For all the other doctors (non-hospitalists) who saw patients, all four ratings essentially remained the same before and after this one-year period.

    If these increases seem small, remember that these ratings had been getting worse before the start of the program. Now they were improving.

    The authors emphasize the expected generalizability of these results — if it can work for one group of doctors, they see no reason that it couldn't for others. They also emphasize that the program was neither costly nor time intensive.

    The study appears in the American Journal of Medical Quality and is freely available.

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